Takes Two to Play This Game

“The only event where you are disqualified if found negative for drugs”—Rich Smith, World, European, and British Double Gold Medal Cyclist

Sport as a drug

It was a Friday night and I couldn’t sleep. The twin suite at Gothenburg’s Gothia Towers was filled by the breaths of my room-mate Nick. It was a little louder than normal, maybe, probably, but it was not the volume that disturbed me. The sheer enormity of its existence and the existence of all that I had witnessed in the past week kept me awake. When he breathed out I thought of all the people I had met and spoken with in the past week. A deep inhale of breath reminded me of just how welcoming this community had been. Exhale that generosity found me sleeping in this four star team hotel. Inhale; at least two hundred people I had spoken to or shared a beer with would not have been in Sweden without organ donation and the gift of life.

This was the World Transplant Games. My roommate Nick Condon was using his second pair of lungs to compete for the United Kingdom in the Athletics and Golf.

As we got ready for bed I tried to keep myself busy, focusing on my book as Nick lined up his collection of pills and injected himself with insulin. Athletes had spoken of the length of this routine but here it was played out before my eyes.

For the World Transplant Games Federation, priority one is drugs compliance: You must be taking your meds. Transplant recipients receive anti-rejection drugs that they must continue to take for the rest of their lives. All cells within your body go through a form of regeneration, but replacement cells present the same characteristics as their predecessor. A donated organ will always remain ‘alien’ to the body’s immune system and so must be protected from rejection.

“The drugs are dirty drugs, they have nasty side effects, they make you ill but they keep you alive, death isn’t a side effect.”

The side effects of the operation and rejection drugs mean further drugs are administered to transplant patients. The news of a cyclist found using erythropoietin (EPO) has become all too common in the Tour de France and the Olympics. Chris Foster, cyclist at the World Transplant Games admitted to having used EPO. A large number of athletes at the World Transplant Games will test positive for this performance enhancing drug, but for its original medical purpose.

Chris explained that in kidney transplant patients, EPO replaces the damaged kidney’s version of a chemical designed to encourage the production of hemoglobin. Hemoglobin in the blood carries oxygen from the lungs to the muscle tissue, helping to burn the nutrients required to provide energy. A high hemoglobin count provides increased endurance and since the 1980s sport suffered from the practice of blood doping.

There are potentially risky consequences to artificially increased hemoglobin. The risks of stroke, blindness and further kidney damage are increased. Even following injections of EPO, Chris’s levels of hemoglobin are only raised to 50–75 percent of that of a healthy individual. Transplant athletes’ kidneys will continue to perform at below average function.

The World Transplant Games Federation was recently accepted as an affiliate organisation into the International Olympic Committee fold. Such recognition requires the WTGF to consider their anti-doping policy and introduce Therapeutic Use Exemption certificates. These require cyclists and other athletes to declare and be approved for taking EPO or any other drug on the World Anti-Doping Agency’s prohibited list.

This development was providing some debate and confusion in the Gothenburg athletes’ village. Some were unsure of this new regime, they disliked the concept for they could not imagine anyone cheating to gain a competitive advantage at these games. They were struggling to understand what the affiliation to the IOC provided apart from increased bureaucracy and invasion into their medical history. Events to transpire at the Athletics track would question their beliefs on the first count but the latter concerns would gain validity on ‘Olympic Day’.

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A series of medical lectures in both English and Swedish were a sensible and welcome addition to the games. In the opening lecture, President of the WTGF, Oliver Coustere laid out the games second priority.

“Priority two is to encourage the readaptation to exercise. Providing an autonomous pathway to encourage transplant recipients into regular exercise.” Figures were presented showing that following a transplant, those patients engaged in 20 exercise sessions showed a 20–30 percent improvement in respiratory capacity.

The games first received 99 participants in Portsmouth, England, 1978. They were founded by British consultant surgeon Maurice Slapack. They would promote the benefits and awareness of organ donation to the public and promote the benefits of sport and physical activity to transplant recipients.

At that time many recipients were still advised to avoid such exercise as being too strenuous for their condition. Coustere; a transplant recipient himself was considered to be risking his body by participating in these games in the 1980s.

The British South coast again welcomed representatives from seven countries in 1979. The following year the games went transatlantic as New York took responsibility for the games before they moved to Athens in 1982.

The WTGF’s focus in the 1980s was to keep itself and its participants alive. Research began to prove their case and by the end of the decade, insurance purposes required the invention of ‘Medical Sports Transplantation’, as a whole new field of study.

The 1990s saw breakthroughs with studies determining that Physical and Sport Activity was non deleterious for grafts and should be prescribed as additional therapy.

The games and studies moved into the 21st century with a focus on improving ‘Quality of Life’ for organ recipients. The lecture asserted this as an acceptance that such quality is multi-disciplinary and includes medical, psychological, physiological, dermatological, even sexological.

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The World Transplant Games continues to only include non contact sports due to the fear of injury. The Gothenburg games did include one sport where participants might make contact with one another. To reflex the games setting, the popular Scandinavian sport of Floorball was included for the first time and proved such a hit that participants who had never previously heard of the game protested for its inclusion in the 2013 Games.

Those not from Scandinavia are probably more familiar with the game under the name of a popular manufacturing brand associated with the sport and days when the weather outside were unsuitable for P.E. class; Unihoc. The game is a sports hall version of ice hockey, with plastic sticks, a plastic ball and trainers to replace the ice skates.

The gold medal match was played between Sweden and Finland whilst on court number 2, the bronze medal game had turned into the Commonwealth championship decider as the United Kingdom took on Australia. Neither team had played the game competitively before arriving in Sweden and this non-contact sport started to look like a real game of ice hockey.

Joe Matthews, the UK’s big number 10 was already getting stick from his team as the team’s enforcer after he’d accidentally speared a child off the pitch, who was playing for the Swedish opposition in the last of the group games.

Joe wasn’t afraid of a little contact in his sport, he’d gone to the United States on a rugby scholarship. It was in the college dorms where he had challenged his mate to a stair race. Joe never lost this challenge, but this time he couldn’t make the top. After going to his doctor’s, a chain of events led to his admission into hospital and Joe subsequently suffering a heart attack, where he was clinically dead for over five minutes.

When Joe received his new heart, he questioned his surgeon, would he be able to play Rugby again? Luckily his surgeon was positive about the effects of physical activity and saw no physical reason why Joe couldn’t return to Rugby, the question would be more one of motivation, could Joe push himself to return to such levels of fitness again?

Two years later Joe got the all clear to return to the games, “the only difference is now I wear those shoulder pads with a sternum plate.”

I’d noticed a lot of transplant athletes bruised easily but Joe didn’t seem to display any at all. “I’ve never bruised that badly, but then I’ve always taken measures to treat them before they come up. I’ve played rugby since I was six and I’ve learnt to look after myself. If I’ve got a knock then the ice packs go on straight after the games.” Joe’s knowledge as a sportsman actually seemed to be helping him manage the side-effects of his transplantation.

Still, this does not mean that the promotion of physical activity as therapeutic activity is encouraged by all surgeons. The varied experience and pathways that led participants to these games is evidence of that.

Bubbly and loudly cheering on her compatriots, I met one British tennis player by the swimming pool and wanted to know how she had come to hear of the games?

“I was in the unit for a check up, saw a load of tracksuits and thought, they look nice, I fancy one of them.” Her doctor had never mentioned the games to her but she admitted that in the past sport had never been a big thing for her. “Before a tournament I’m playing tennis two or three times a week for maybe four months prior.” Of course it’s a shame she’s not playing all year round but were it not for the tournaments and the opportunity to pull on a team tracksuit, she wouldn’t be playing at all.

A spectrum of ability

The Olympic Charter, Chapter 1, section 6 states “The Olympic Games are competitions between athletes in individual or team events and not between countries.”

In 1924, de Coubertin presided over debates on whether to adopt an official medal table. The official report of the French Organising Committee of the 1924 Paris Games used a system that allocated points to the top six finishers; 10-5-4-3-2-1. Its main competitor was a system that allocated 7 points for the gold.

Another system commonly attributed to American General Douglas MacArthur, divided points by population. Under this system, Paea Wolfgramm’s silver medal in the Atlanta ’96 Super Heavyweight Boxing division would have seen Tonga secure the Olympic team championship.

No official scoring system was ever sanctioned by the IOC, though journalists and government targets continue to create unofficial tables. The British Quango or Quasi-non governmental organisation UK Sport set a target of eighth in the medal table for Beijing and a top four finish for London.

As the IOC now limits the number of competitors from each country in a specific event and includes a parade of nations, the Olympics have long been an implicit competition between states.

The World Transplant Games is explicit in its competition, 3 points are awarded for gold, two for silver and one for bronze. In Gothenburg, the United Kingdom sat comfortably atop the table. 612 points came from 115 Gold, 95 Silver and 77 Bronze medals. Nearest rivals, the United States of America collected 244 points from 47 gold, 38 silver and 27 bronze.

All the Brits insisted competition was getting tougher. Some had coasted to victory in previous games but now struggled to replicate those results. Racquet sports appeared a particularly competitive front. The increase in challenge came not only from the influx of South-East Asian competitors to the games, but in a general increase in talent across the world.

As tricky as this was for British medal aspirations, they had to admit that this was a measure of the games success. The numbers of transplant recipients are growing world-wide. The commitment to sport and physical activity in post-operative life is also on the rise. The quality of these games will continue to increase much as the quality of the Paralympic Games did.

The first official Paralympics were held in Rome, 1960. Every competitor secured a medal and 10 nations shared the spoils. In no event were there ever more than three participants or teams. At the Beijing 2008 Paralympics, athletes from 76 nations had a medal placed around their necks.

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Participants vary wildly in their sporting experience, ability and aims. It is the shared ambition of these games that makes for a special event. Gothenburg’s motto was that these would be the “Games for the winners”. All athletes had won their battle to make the start line.

At one end of this spectrum was Team USA’s Howard Dell, one time part of the 1988 Olympic Canadian bobsleigh team, professional NFL american football player and actor in daytime soap The Young and the Restless. Canadian Dell has an American liver following his emergency transplant in November 2009. Newspaper reports about Dell’s return to competitive sports pointed out that “Although he had some insurance from his days as an actor, the transplant cost Dell $700,000 - a bill that forced him to liquidate all his assets and forced him into bankruptcy.”

I met Howard in line to the athletics tuck shop.

“Had a good week? How d’you get on?”

“OK, Performances could have been stronger.”

“Yeah, what d’ya come away with?”

“Three World Records and four medals, three gold.”

“Right so that’ll be the professional athlete in you that’s disappointed then?”

Dell was a sprinter and he really wanted the 100m gold. With a pre-transplant best of 10.41 in the 100m he had the ambition to clock a flat 12 seconds as a 49 year old. 11.99 won the 40-49 year olds category, set by Xabier Lacosta of Spain, the quickest athlete of the week. Dell can look forward to 2013, his 12.74 was over a second quicker than anyone in the 50-59 category.

Dell had visited both the Winter Olympics and the World Transplant Games as an athlete and I wanted to know how they compared.

“Apples and oranges, man, they’re completely different fruits. These games mean something extra because everybody has been through this with you. They understand what you’ve achieved just to be here. Back home, they say ‘Oh, I hear you’ve had a transplant’, like you’ve just had your tonsils out. People here understand. I’m competing with a guy who had his liver transplant twenty years ago - I just hope I’m doing that when I’m twenty.”

At the other end of the spectrum with Team USA was cyclist Lacey Wood. Now in her early twenties, Lacey had received her new heart aged only eighteen months and her new kidney in 2006. Stood at the top of the time trial’s steep opening climb I chatted with her university coach, Paul Drake. Paul described his first experiences of coaching Lacey, when he noticed the lack of circulation in her sheet white legs.

“I pulled her aside to check that she was alright and she said ‘well yeh, you know I’ve had a heart and kidney transplant right?’ Nobody had told me. She asked me to train her for the World Transplant Games as no-one else was prepared to take on due to the perceived risk in coaching her. We’ve spent months just trying to work out the best regimen to administer her drugs, so she can train effectively. I came here because I wanted to see the event and help her reach the start and the finish line. After this we can think about improving performance.”